Failure of lumbar disc surgery: management by fusion or arthroplasty?

PURPOSE: To analyze and clarify conflicting aspects of fusion and total disc replacement (TDR) surgery in literature. METHOD: Using keywords, 23 literature reviews, 41 studies accepted by "importance criteria" from the Internet, and 16 articles "published in 2018" were chosen. Altogether 80 studies. RESULTS: General assessment was mentioned as affirmative for TDR in 40 papers, five were negative, 24 without clear decision. Long term results TDR seven affirmative, four nondecisive. Comparison to fusion (general, ALIF, 3600, BAK cage) 18 found as better, nine equal, one nondecisive. Complications TDR 3-50%. Adjacent disc degeneration disease recognized in 14 papers, denied existence in four. Cost-benefit effective in three papers comparing to fusions, ALIF, 3600. Nonimbursement from the state mentioned as problem in three papers. Salvage surgery seven papers, rare but extremely problematic. Anterior approach 16 challenging surgery, one 10% minor, one 38.5% transient complications, one 1.8% retrograde ejaculations, one 6.6% vascular injuries, two access surgeon needed. Construct judgment two no importance, 22 wear and durability problems, two inadequate biomechanics and biomaterials, three construct and lateral approach. Impact of TDR upon spine surgery is decreasing, currently is less than 2%. CONCLUSION: It is concluded that problems with anterior surgery, imbursement policy, and potential problems with salvage surgery are major reasons for loosing popularity of TDR surgery.

Large chondrosarcoma of the lumbar spine--a rare yet important cause of lower back pain.

We report a case of a large chondrosarcoma of an L4 vertebral body causing iliac vein thrombosis. The slow-growing tumor eluded definitive diagnosis early in its development since the main symptom it caused was only lower back pain. Five years after onset of the disease, the patient presented with fever, tenderness and swelling in the leg, the tumor was diagnosed and found to be exerting a mass effect causing further pain and compressing the left common iliac vein. Due to inoperability of the tumor, a multidisciplinary surgical approach was used to resect the majority of the tumor as apalliative measure and rid the patient of her symptoms. Due to the chemoresistance and relative radioresistance of these tumors, prompt full surgical resection before the tumor invades vital structures remains the mainstay of successful treatment of chondrosarcoma of the spine.

[New techniques and prospects in invasive treatment in vertebrology]. / Novosti i perspektive u invazivnom lijecenju u vertebrologiji.

In this article authors outline new techniques and prospects in invasive treatment in vertebrology with emphasis on interventional and semi invasive procedures and minimally invasive surgery for lumbar disc herniation. They describe new approaches in neuroablative procedures for back pain treatment, in spinal fixation and in surgical treatment of scoliosis. Authors also report methods of great expectations which are not yet in use in our clinical practice but are promising like reconstruction of nucleus pulposus by autologous chondrocytes transplantation. New methods in cervical spine surgery are also discussed. The efficacy of each surgical method is pointed out. Apart from being informative, together with the corresponding article on patophysiology, magnetic resonance imaging and conservative treatment, these articles considering recent developments can be used as an aid in decision making when approaching these patients.

[What a rheumatologist must know about spine surgery?]. / Sto reumatolog mora znati o kirurgiji kraljeznice?

Spine surgery is a matter of interest of several specialities. The development of new instrumentations brought a number of new operative techniques. Minimally invasive surgery, endoscopy, offers superior results, but first disapontiments appear as well. What to operate, when and how? A schematic presentation of pathology, operative procedures and indications are presented.

Lost in projection - Implicit features experience of 3D architectural forms and their projections.

The aim of our study was to investigate whether the experience of objects' implicit features would change if we observe it as a real 3D object or as a photograph or a drawing. In our experiment 46 participants estimated their impression of 10 objects shown in four different presentations. As stimuli, we used 3D objects, their virtual reality models, photographs and drawings from four different viewing directions, created by architecture students. As a measure of implicit features experience we used 12 bipolar adjectives grouped into four factors (attractiveness, regularity, arousal, and calmness) and 3 adjectives forming aesthetic experience factor. Results show significant differences between types of object presentations on four factors of implicit features experience, but not on the aesthetic experience factor. Real 3D objects were experienced as more attractive and calm, while VR presentation showed reduced arousal than other presentation types. On regularity VR and real 3D objects were experienced as same and more regular then drawings and photographs.

Changes in pulmonary functional parameters after surgical treatment of idiopathic scoliosis.

There is a controversy in results about influence of surgery on pulmonary function in idiopathic scoliosis. The aim of the study was to study pulmonary function in severe thoracic idiopathic scoliosis and to detect changes in pulmonary function after the three-dimensional anterior surgical correction in severe thoracic scoliosis. 91 patients at the age of 16 +/- 5.1 yrs underwent surgery in order to make a correction of scoliotic deformity. All the curves were greater than 70 degrees (86 +/- 5.1). Group I consisted of 60 patients with scoliotic curves between 70 degrees and 100 degrees, while group II consisted of 31 patients with curves greater than 100 degrees. All the patients were operated by anterior instrumentation and the average correction was 74% +/- 15 for group I, and 71% +/- 18 for group II. Vital capacity (VC) and forced expiratory volume in the first second (FEV1) in group I remained unchanged. In group II, VC improved for 11%, while forced expiratory volume (FEV) improved for 13.6%. Our conclusion is that there is a significant correlation between the percentage of achieved correction and pulmonary function.

Relationship between clinical contourometric measurements and vertebral rotation in adolescent idiopathic scoliosis.

The relationship between trunk and spine deformity has yet not been well defined. The purpose of this study was to identify the relationship between clinical (contourometric) and radiographic methods of scoliotic deformity evaluation. Our second objective was to create mathematical formulas for calculating radiographic parameters based on defined correlations of multiple parameters. We did a study of 136 preoperatively analysed patients with idiopathic scoliosis. Altogether, 189 lateral curvatures were assessed. Based on Lenke's classification, curves were divided into three groups: a thoracic, a thoracolumbar and a lumbar curve group. Each group was analyzed separately to determine relationships between clinical contourometric (scoliometer value, humpometer values) and radiographic measurement (apical vertebral rotation (AVR) according to Drerup). On the grounds of statistically significant correlation coefficients of most clinical parameters and Drerup rotation we found good relationships between trunk and spine deformity. Using the best correlated clinical parameters and multiple regression statistical analysis we created mathematical formulas for prediction of scoliotic AVR in higher degree curves.

When a river is affected by a reservoir: Trophic interactions and flexibility in feeding strategies of alpine bullhead (Cottus poecilopus) and European bullhead (Cottus gobio).

The alpine bullhead and European bullhead are benthic fish species protected by law in several European countries. One of the problems of European rivers is the ever-increasing number of reservoirs, which has adverse impacts on aquatic ecosystems. Feeding ecology of both species evaluated separately has been a subject of several studies, however, none of the studies paid attention to feeding interactions between them. Thus, the aims of the study were to evaluate trophic interactions of the two bullhead species and to assess their ability to cope with environmental disturbances caused by a reservoir. The study area consisted of three sites on the river Cierny Váh (Slovakia) that differed from each other by the intensity of pressures posed by the reservoir. The two species were found to coexist at two sites below the reservoir, because the reservoir affected their distribution along the river. For alpine bullhead, chironomid, hydropsychid and baetid larvae were the most important prey items, whereas the diet spectrum of European bullhead contained hydropsychid, chironomid larvae and detritus. Differences in diet composition were found among sampling sites. Temporal variations in the diet composition demonstrated that alpine bullhead is a more flexible feeder than European bullhead. Being predominantly food generalists, both species were able to shift their feeding strategies towards specialization when exposed to environmental disturbances at the most affected site. The reservoir increased the diet overlap between the two species, and thus changed their trophic interactions. Both alpine bullhead and European bullhead managed to cope with environmental disturbances caused by the reservoir, however, in lower population densities. Moreover, the reduced diversity of resources increased the potential for trophic competition between them.

Anterior instrumentation for correction of adolescent thoracic idiopathic scoliosis: historic prospective study.

AIM: To compare the results of anterior instrumentation and standard posterior procedure for correction of adolescent thoracic idiopathic scoliosis. METHODS: The study included 50 patients with adolescent thoracic idiopathic scoliosis who underwent corrective spinal surgery. Anterior spinal fusion by use of modified Zielke ventral derotation system (anterior approach to spine through thorax) was performed in 25 patients, whereas posterior approach was used in 25 patients. The average preoperative thoracic curve in coronal plane was 66.7 +/- 9.9 degrees and 65.0 +/- 11.7 degrees in the anterior and posterior correction groups, respectively. The median age of patients before surgery was 14 years (range, 12-18) in the anterior and 16 years (range, 13-18) in the posterior correction group. Women-to-men ratio was 22 to 3 in each group. Coronal and sagittal correction, apical vertebral body rotation, rib hump, and rib depression correction were measured before surgery and at the first (30 days after surgery) and at the second follow-up visit (at least 2 years after surgery). Posteroanterior and laterolateral radiographs of the erect spine were used (according to the method of Cobb and Nash-Moe) to assess coronal, sagittal, and horizontal plane corrections. Rib hump and rib depression were measured with Thulbourne-Gillespie measuring device. The differences in scoliosis correction parameters in the two groups were tested with Student two-tailed t test. RESULTS: In the coronal plane, the thoracic curve of 66.7 +/- 9.9 degrees before surgery in the anterior correction group was reduced to 14.8 +/- 8.7 degrees after surgery (78.1 +/- 12.4% relative correction), and the curve of 65.0 +/- 11.7 degrees in the posterior correction group was corrected to 29.2 +/- 7.8 degrees after surgery (55.1 +/- 8.6% relative correction) (P<0.001). Apical vertebral body rotation correction according to the Nash-Moe classification from 2.0 +/- 0.4 degrees to 0.8 +/- 0.6 degrees was achieved in the anterior correction group (62.0 +/- 26.6% relative correction) and from 1.7 +/- 0.5 degrees to 1.4 +/- 0.5 degrees in the posterior correction group (12.0 +/- 21.8% relative correction) (P<0.001). Rib hump correction from 22.4 +/- 15.5 mm to 5.4 +/- 5.2 mm was found in the anterior correction group (70.9 +/- 26.0% relative correction) and from 25.3 +/- 7.0 mm to 13.6 +/- 6.8 mm (48.4 +/- 16.5% relative correction) in the posterior correction group (P = 0.084). CONCLUSION: Compared with the standard posterior approach, the anterior approach resulted in better three-dimensional correction of idiopathic thoracic scoliosis.

Ontogenetic variations in the diet of two invasive gobies, Neogobius melanostomus (Pallas, 1814) and Ponticola kessleri (Günther, 1861), from the middle Danube (Slovakia) with notice on their potential impact on benthic invertebrate communities.

In this study, ontogenetic variations in diet of invasive bighead goby Ponticola kessleri and round goby Neogobius melanostomus from the middle Danube were analysed. Index of stomach fullness, Fulton's condition factor, index of food importance, frequency of occurrence, biomass, electivity, and proportions of invasive organisms in their diet were examined. Changes in the diet during ontogeny of both species emphasise the differences in their trophic niches. Our results combined with literary data suggest that bighead goby may threaten small native benthic fish species as a predator (especially in the invasion front), whereas round goby can potentially impact native fish species of all ontogenetic phases by competing for food. Round goby appear to have strong impact on bivalves, especially in the invasion front. High consumption of invasive organisms by bighead goby may help the native macroinvertebrate community. Thus, in contrast to round goby, bighead goby does not seem to be a hot candidate for being a nuisance invader.

Synchrony and heterochrony in ontogeny (of fish).

The ontogeny of an organism is a complex process that strongly depends on the timing of developmental processes. In this article, I discuss ontogeny of fish (and other organisms) in temporal terms, based on the hypothesis that organisms as self-organized entities may create their own times for their development, and that this development consists of a sequence of longer stabilized states (steps) with shorter, intermittent less-stable intervals (thresholds). If viewed within the context of structure-to-structure, organ-to-organ and/or organism-to-environment relationships, then the saltatory pattern of ontogeny emerges at each transition from one stabilized state to another. I consider two timing mechanisms essential to ontogeny - synchrony (coordinating) and heterochrony (implementing); their possible roles are discussed. Besides this, a new context and understanding for the term heterochrony is proposed. At least three levels of heterochrony should be distinguished: interspecific, intraspecific and intraindividual. However, the difference among these three types of heterochrony is not in the phenomenon itself but in the way we perceive and classify it.